Dr Tu Youyou has been honoured for her work in the field of antimalarial drugs. Credit: China Daily/Reuters

The Guardian; October 30, 2015. What does it take to bring the fruits of scientific innovation to vulnerable patients in the world’s poorest communities? The discoveries recognised by the 2015 Nobel prize for medicine are perfect examples of the journey from test tube to bedside, and tell a fascinating geopolitical story of how effective drugs for neglected diseases are discovered, made, and distributed. Importantly, they show what happens when we work together for patients, not just profits.

The Nobel recipient Dr Tu Youyou is credited with the discovery of artemisinin, which led to the current arsenal of antimalarial drugs – artemisinin-based combination treatments (ACTs) that have saved millions of lives.

Similarly, avermectin, the compound discovered by the other two recipients,professors Satoshi Omura and William Campbell, generated the drug ivermectin, an effective treatment against river blindness and lymphatic filariasis, diseases that cause immense suffering and severe disfigurement.

When these discoveries were made in the 1970s, there was a desperate lack of research and development for diseases that were devastating poor communities in Africa, Asia and Latin America. It was the start of more attention from UN agencies, and the development of numerous organisations to build this capacity.

Tu was able to get support for her discovery from international and national research institutions, and forged connections with key international pharmaceutical companies. They in turn partnered with new, not-for-profit research foundations to ensure the development of badly needed ACTs that met World Health Organisation recommendations for adults and children.

Political will eventually coalesced, resulting in a twentyfold increase in malaria funding from 2000 until 2015. To date, artemisinin-based antimalarials have been delivered to more than 600 million people. Treatment for river blindness and lymphatic filariasis benefited from a similar private-public collaboration. But sadly these important advances were exceptions, particularly for poverty-related diseases where commercial incentives for research are not sustainable.

Despite the impressive pipeline for neglected diseases, there are still major gaps. Even malaria, river blindness, and lymphatic filariasis need more research and development, for new products and distribution strategies. Resistance to artemisinin has been detected in Cambodia, Laos, Thailand, Vietnam and Myanmar. Meanwhile, ivermectin is extremely effective but only kills the juvenile worms in human hosts. To beat river blindness and lymphatic filariasis once and for all, new drugs that kill adult worms will be needed.

The challenge now is to ensure that scientific and political momentum is not only sustained but expanded and, importantly, coordinated and financed. The recentG7 summit decided to extend research activities in the field of poverty-related infectious diseases. Clearly, new mechanisms – currently being explored – will be needed to define public health priorities in order to anticipate and appropriately respond to crises such as that of Ebola and the growing threat of antibiotic resistance. New financial models are required to complement current governmental and philanthropic investment efforts.

This year’s Nobel prize was given to the creators of what became truly life-saving medicines. Other brilliant young scientists, especially in countries affected by these neglected diseases, are certainly among us today, and are equally committed to addressing the unmet medical needs of the millions suffering and dying from diseases of poverty.

As members of the global health community, it is our duty to ensure existing science is quickly brought to bear for the millions in need of new treatments, and that distribution keeps pace so that the poorest patients are not left behind. We also need to provide the resources for the next generation of scientists. Now, more than ever, a globally coordinated response is needed to ensure that great discoveries and innovation reach the bedside of all patients, no matter where they live.

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